Child Details

After class, child will : (Please note that carpoolers will go to ASP if they are not picked up within 10 minutes after the class ends.)

Be picked up at Car Pool
Attend ASP

Special Services: Does your student receive any services that will impact your student's participation?*

Yes
No

Special Education/IEP
504 plan

Medical/Allergies/ Special Services*
(If no known special issues, please enter none)

Parent/Guardian Initials*

Date*

I hereby agree to release and hold harmless , its officers, trustees, and representatives and , its employees and representatives, from any responsibility, loss, liability, damage or costs which Participant may incur in this after school program whether caused by the negligence of and/or (Programs), the negligence of Participant and/or others, or due to accidental occurrences. In the case of injury or medical emergency involving Participant, if a parent or guardian cannot be reached, I give the Program representative(s) permission to seek appropriate first aid or medical care and I agree to be fully responsible for the cost of any services provided.

REFUNDS AND MAKE-UP CLASSES POLICIES:

Programs will be cancelled when school is not in session due to any reason, including early release for weather conditions.

The individual school determines Make Up classes and Playin’ On Purpose cannot guarantee make up classes.

Playin On Purpose does not offer make-up classes if a child is absent from school due to illness or field trips. Refunds will not be issued for non- attendance of a scheduled class.

No refund after the first 2 weeks of the session.

Should Playin’ On Purpose find it necessary to de-register a child, a refund will be issued after deduction for classes already attended.

A $15.00 administration fee will be applied to any refund issued.

PHOTOGRAPHS:

I do hereby consent and agree that Playin’ On Purpose has the right to take photographs of my child and to use these on the company website and promotional material without compensation. Your child’s name and identity will be withheld.

AGREEMENT TO PARTICIPATE IN PLAYBALL

Participation in all sports can be inherently dangerous and, regardless of the care taken to avoid injury, it is impossible to ensure the safety of all participating individuals.

While participating in Playball, accidents do happen. Some of these accidents may be minor like collisions with other players, collisions with the ground, and being struck by the ball or objects. Other injuries may also include:

To reduce the risk of injury, participants are expected to abide by the following rules:

All participants are expected to be physically fit before Playball begins.

All players must adhere to the rules of sports, thus creating a safe playing environment.

The above-mentioned participant agrees to follow the preceding safety rules, all posted safety rules, and all rules common to sports. Further, the above-mentioned participant agrees to report any unsafe practices, conditions, or equipment to the Playball instructor.

I certify that the above-mentioned participant 1) possesses a sufficient degree of physical fitness to safely participate in Playball, 2) understands that he/she is to discontinue activity at any time he/she feels undue discomfort or stress, and 3) has indicated in the “Special Needs” section any health-related conditions that might affect his/her ability to play in Playball and he/she will verbally inform the Playball instructor immediately.
I have read the preceding information and it has been explained to me. I know, understand, and appreciate the risks associated with participation in Playball and I am voluntarily participating the above-mentioned participant in the activity. In doing so, the above-mentioned participant is assuming all of the inherent risks of sports. I further understand that in the event of a medical emergency, Playball will call EMS to render assistance and that I will be financially responsible for any expenses involved.

WAIVER OF LIABILITY:

In consideration of being permitted to play in Playball on behalf of myself, my family, my heirs, and my assigns, I hereby release Playball, its agents, and its employees from liability for injury, loss, or death to the above-mentioned participant while using any facility or equipment or in any way associated with participating in the activities Playball offers now or in the future, resulting from the ordinary negligence of Playball, its agents and employees.